Sleep

disorder
 Introduction
Content:
Definition of sleep disorder

Types of sleep wake disorder

Risk factors & causes of disorder

Diagnostic criteria , prevalence, and treatment for each type.

Nursing care for patient with sleep wake disorder.

Introduction:

Sleep an experience that occupies nearly one third of our

life, is a recurrent , altered state of consciousness that
occurs for sustained periods , restoring a person’s energy
and wellbeing .

The primary function of sleep is to allow the body to

restore itself and prepare for next day.
Scientists now know that sleep problems and disorders
have a serious impact on an individual’s physical and
mental
health.
Sleep disorder have been linked to other mental disorder
such depression and psychosis in fact.
67% of patients seen at asleep disorder reported an
episode of depression within the previous five years.
 Definition:

Sleep disorder are ongoing disruptions of normal

waking and sleeping pattern which lead to excessive
day time sleepiness, inappropriate or inopportune
naps, chronic fatigue and the inability to perform
safely or properly at work , school , or home .
The DSM-5 classification The DSM-5 classification of
sleep-wake disorders is intended for use by general
mental health and medical clinicians, Sleep-wake
disorders encompass 10 disorders or disorder
groups:
 Hypersomnolence Breathing-related sleep
Insomnia disorder, Narcolepsy,
disorder, disorders,

Nightmare disorder, Rapid eye movement

.Non-rapid eye (NREM) sleep arousal
(REM) sleep behavior
movemen disorders,
disorder,

Substance/medication-
induced sleep disorder
Restless legs Circadian rhythm
syndrome, sleep-wake disorders,
 Individuals with these
disorders typically present
with sleep-wake complaints
of dissatisfaction regarding
the quality, timing, and
amount of sleep. Resulting
daytime distress and
impairment are core
features shared by all of
these sleep-wake disorders.
Measurement of sleep:
• This is usually done in a sleep laboratory or a sleep
centre. Technicians attach electrodes to the head to
take three types of measurement which include:

• First, electrical activity in the brain is measured by

electroencephalography (EEG). This measure is used
because the EEG signals associated with being awake
are different from those found during sleep. Also, the
different stages of sleep can be measured using EEG.
 Second, muscle activity is
measured using electromyography
(EMG), because muscle tone also
differs between wakefulness and
sleep. Once again, there are EMG
differences within sleep,
depending upon the stage of
sleep.
(Demonstrate muscle movement
during sleep. This is helpful in
documenting a wake period, an
arousal, or just a spastic
movement.)
This Photo by Unknown Author is licensed under CC BY
• Third, eye movements during
sleep are measured using
electro-oculography (EOG).
This is a very specific
measurement that helps to
identify Rapid Eye Movement
or REM sleep, during which
we often dream. The eyeballs
make characteristic
movements that show us
when someone is in this type
of sleep.
• This whole system of assessment
is usually called polysomnography
(PSG). The prefix 'poly' simply
refers to the fact that more than
one type of physiological activity
is being measured.

• Electroencephalography (EEG) .
This measures brain wave
activity.
• Electrooculogram (EOG). This
measures eye movement.
• Electromyography (EMG). This
measures muscle movement.
 There are two basic forms of sleep:
Rapid eye movement (REM) sleep and non-rapid REM (NREM) sleep.
(REM sleep is sometimes called "paradoxical sleep.") Infants spend about 50% of their sleep
time in NREM and 50% in REM sleep.
Adults spend about 20% of their sleep time in REM and 80% in NREM sleep. Elderly people
spend less than 15% of their sleep time in REM sleep.
 1.Insomnia Disorder :
The inability to get the amount of sleep you
need to wake up feeling rested and refreshed is
the most common sleep complaint.
Diagnostic Criteria:

A . A predominant complaint of dissatisfaction with /sleep quantity or quality, associated

with one (or more) of the following symptoms:

1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep
without caregiver intervention.)
2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning

to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep
without caregiver intervention.
3. Early-morning awakening with inability to return to sleep.
B. The sleep disturbance causes clinically significant distress or
impairment in social, occupational, educational, academic, behavioral, or
other important areas of functioning.
C. The sleep difficulty occurs at least 3 nights per week.
D. The sleep difficulty is present for at least 3 months
E. The sleep difficulty occurs despite adequate opportunity for sleep. .
• F. The insomnia is not better explained by and does not occur
exclusively during the course of another sleep-wake disorder (e.g.,
narcolepsy, a breathing-related sleep disorder, a circadian rhythm
sleep-wake disorder, a parasomnia).
• G. The insomnia is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication).
• H. Coexisting mental disorders and medical conditions do not
adequately explain the predominant complaint of insomnia.
Specify if:
❖ With non-sleep disorder mental comorbidity,
including substance use disorders
❖ With other medical comorbidity
❖ With other sleep disorder
Specify if:
Episodic: Symptoms last at least 1 month but less
than 3 months.
Persistent: Symptoms last 3 months or longer.
Recurrent: Two (or more) episodes within the space
of 1 year.
• Prevalence:
• Insomnia disorder is the most prevalent of all sleep
disorders.
• In primary care settings, approximately 10%-20% of
individuals complain of significant insomnia symptoms.
• Insomnia is a more prevalent complaint among females
than among males, with a gender ratio of about 1.44:1.
 Causes of insomnia:
❖ Sleep habits we learned as children
may affect our sleep behaviors as
adults. When we repeat these
behaviors over many years, they
become habits.
❖ Poor sleep or lifestyle habits that
may cause insomnia or make it
worse:
❖ Going to bed at different times
each night
❖ Daytime napping
❖ Poor sleeping environment, such
❖ Spending too much time in bed while awake
❖ Working evening or night shifts
❖ Not getting enough exercise
❖ Using the television, computer, or smartphone
❖ the use of some medications and drugs may also affect sleep:
❖ Alcohol or other drugs , Heavy smoking,Too much caffeine, especially
late in the day
 ❖Getting used to certain types of sleep
medications
❖ Some cold medications and diet pills, other
medicines, herbs, or supplements prescribed
by a health care provider or bought on your
own .
❖ Physical pain or discomfort
❖ Stress, whether it is short-term or long-term.
For some people, the stress caused by the
insomnia makes it even harder to fall asleep.
❖ Physical, social, and mental health issues can affect sleep patterns,
including:
❖ Anxiety disorders
❖ Bipolar disorder
❖ Certain medical conditions, such as thyroid disease
❖ Feeling sad or depressed. Often, insomnia is the symptom that
causes people with depression to seek medical help.
Risk factors:
❖ Insomnia affects people of all age
groups but people in the following
Groups have a higher chance of
acquiring insomnia:
❖ Individuals older than 60
❖ History of mental health disorder
including depression, etc.
❖ Emotional stress
❖ Working late night shifts
❖ Travelling through different time
zones
Treatment:

Behavior therapies
include:
• Education about good sleeping
habits:
• By Sleep hygiene teaches
habits that promote good
sleep.
 Relaxation techniques:
Progressive muscle relaxation, biofeedback and breathing exercises
are ways to reduce anxiety at bedtime. These strategies help you
control your breathing, heart rate, muscle tension and mood.

Cognitive behavioral therapy:

This involves replacing worries about not sleeping with positive
thoughts. Cognitive behavioral therapy can be taught through one-
on-one counseling or in group sessions.

Stimulus control:
This means limiting the time you spend awake in bed and associating
your bed and bedroom only with sleep and sex.
Sleep restriction:
This treatment decreases the time you spend in bed,
causing partial sleep deprivation, which makes you more
tired the next night. Once your sleep has improved, your
time in bed is gradually increased.

Light therapy:
If you fall asleep too early and then awaken too early, you
can use light to push back your internal clock. During times
of the year when it's light outside in the evenings, you go
outside or get light via a medical-grade light box.
2.Hypersomnolence
Disorder
Diagnostic Criteria :
A. Self-reported excessive
sleepiness (hypersomnolence)
despite a main sleep period
lasting at least 7 hours, with at
least one of the following
symptoms:
1. Recurrent periods of sleep or lapses into sleep within the same day.
2. A prolonged main sleep episode of more than 9 hours per day that
is nonrestorative (i.e., unrefreshing )
3. Difficulty being fully awake after abrupt awakening.
a) B. The hypersomnolence occurs at least three times per week, for at least 3
months.
b) C. The hypersomnolence is accompanied by significant distress or
impairment in cognitive, social, occupational, or other important areas of
functioning.
 D. The hypersomnolence is not better explained
by and does not occur exclusively during the
course of another sleep disorder (e.g., narcolepsy,
breathing-related sleep disorder, circadian
rhythm sleep-wake disorder, or a parasomnia).
E. The hypersomnolence is not attributable to the
physiological effects of a substance (e.g., a drug
of abuse, a medication).
• F. Coexisting mental and medical disorders
do not adequately explain the
predominant complaint of
hypersomnolence.
• Specify if:
• With mental disorder, including
substance use disorders
• With medical condition With another
sleep disorder
• Specify if:
• Acute: Duration of less than 1 month.
• Subacute: Duration of 1-3 months.
• Persistent: Duration of more than 3
months.
Specify current severity:
Mild: Difficulty maintaining
daytime alertness 1-2
days/week.
Moderate: Difficulty
maintaining daytime
alertness 3-^ days/week.
Severe: Difficulty maintaining
daytime alertness 5-7
days/week.
Prevalence:

Approximately 5%-10% of individuals who

consult in sleep disorders clinics with complaints
of daytime sleepiness are diagnosed as having
hypersomnolence disorder.

It is estimated that about 1% of the European

and U.S. general population has episodes of
sleep inertia. Hypersomnolence occurs with
relatively equal frequency in males and females.
Causes:
❖ Medical conditions such as
fibromyalgia and low thyroid
function
❖ Mononucleosis or other viral
illnesses
❖ Narcolepsy and other sleep
disorders
❖ Obesity, especially if it causes
obstructive sleep apnea
❖ When no cause for the
sleepiness can be found, it is
called idiopathic hypersomnia.
• Treatments for Hypersomnia :
❖ Treatment for hypersomnia is based upon
the symptoms a person has. Stimulants,
such as amphetamine, methylphenidate,
and modafinil, may be prescribed.
❖ Other drugs used to treat hypersomnia
include clonidine, levodopa, bromocriptine,
antidepressants, and monoamine oxidase
inhibitors.
❖ Changes in behavior (for example avoiding
night work and social activities that delay
bed time) and diet may offer some relief.
Patients should avoid alcohol and caffeine.
3.Narcolepsy:
Excessive sleepiness
characterized by repeated,
irresistible sleep attacks.
After sleeping 10–20
minutes, the person is briefly
refreshed until the next
sleep attack. Sleep attacks
can occur at opportune
times, such as during
important work activities or
while driving a car.
• People with narcolepsy may also experience
cataplexy (sudden episodes of bilateral,
reversible loss of muscle tone that last for
seconds to minutes) or recurrent intrusions of
REM sleep in the sleep–wake transitions,
manifested by paralysis of voluntary muscles
or dream-like hallucinations.
• Treatment includes stimulant medication,
modafinil (Provigil), and behavioral
structuring, such as scheduling naps at
convenient times.
4.Breathing-Related Sleep Disorders :
Breathing-related sleep disorders—Sleep disruption
leading to excessive sleepiness or, less commonly,
insomnia, caused by abnormalities in ventilation during
sleep.
These disorders include obstructive sleep apnea
(repeated episodes of upper airway obstruction), central
sleep apnea (episodic cessation of ventilation without
airway obstruction), and central alveolar
hypoventilation(hypoventilation resulting in low arterial
oxygen levels).
• Central sleep apnea is
more common in the
elderly while obstructive
sleep apnea and central
alveolar hypoventilation
are commonly seen in
obese individuals.

• The primary treatments

for breathing related sleep
disorders are surgical, such
as tracheotomy, and use of
a continuous positive
airway pressure (CPAP)
machine during sleep.
This Photo by Unknown Author is licensed under CC BY
5.Circadian
Rhythm Sleep-
Wake Disorders:
Persistent or
recurring sleep
disruption
resulting from
altered functioning
of circadian rhythm
or a mismatch
between circadian
rhythm and
external demands.
• What is circadian rhythm :
❖ circadian rhythm -- a name given to the "internal body
clock" that regulates the (approximately) 24-hour cycle of
biological processes. The term circadian comes from Latin
words that literally mean around the day. There are patterns
of brain wave activity, hormone production, cell
regeneration, and other biological activities linked to this
24-hour cycle.
❖ The circadian rhythm is important in determining sleeping
patterns such as when we sleep and when we wake, every
24 hours .The normal circadian clock is set by the light-dark
cycle over 24 hours.
• Treatment:
❖Sleep hygiene measures, melatonin,
and bright light therapy can be
effective treatments. Bright light
therapy consists of being exposed to
bright light when wakefulness is
initiated and avoiding bright lights
when sleep is desired.
6.Nightmare disorder:
Repeated awakenings from the major sleep period or naps with detailed recall of
extended and extremely frightening dreams, usually involving threats to survival,
security, or self-esteem
7.Non-Rapid Eye Movement Sleep Arousal Disorders:
Recurrent episodes of incomplete awakening from sleep, usually occurring during the
first third of the major sleep episode, accompanied by either one of the following:
Sleepwalking or Sleep terrors.

8.Rapid Eye Movement Sleep Behavior Disorder:

Repeated episodes of arousal during sleep associated with vocalization and/or
complex motor behaviors.
These behaviors arise during rapid eye movement (REM) sleep and therefore usually
occur more than 90 minutes after sleep onset, are more frequent during the later
portions of the sleep period, and uncommonly occur during daytime naps.
Treatment:
Low doses of clonazepam is most effective with a 90% success rate.
How this drug works to restore REM atonia is unclear: It is thought to
suppress muscle activity, rather than directly restoring atonia.
In addition to medication, it is wise to secure the sleeper's
environment in preparation for episodes by removing potentially
dangerous objects from the bedroom and either place a cushion
round the bed or moving the mattress to the floor for added
protection against injuries
Patients are advised to maintain a normal sleep schedule, avoid sleep
deprivation. Treatment includes regulating neurologic symptoms and
treating any other sleep disorders that might interfere with sleep.
Sleep deprivation, alcohol, certain medications, and other sleep
disorders can all increase RBD and should be avoided if possible
9 .Restless Legs Syndrome
:
Characterized by
insomnia associated with
An urge to move the legs,
usually accompanied by
or in response to
uncomfortable and
unpleasant sensations in
the legs occur at least
three times per week and
have persisted for at least
3 months.
• 10.Substance/Medication-
Induced Sleep Disorder:
• prominent and severe
disturbance in sleep.
• There is evidence from the
history, physical examination, or
laboratory findings of substance
intoxication or withdrawal from
or exposure to a medication
Nursing diagnosis:
The nursing that is usually applied to the patient with asleep
disorder is sleep pattern disturbance , this diagnosis is made
when a disruption of sleep time causes discomfort or
interferes with lifestyle.

1.Sleep pattern disturbance related to changes in usual

sleep evidence by difficulty falling asleep , mood alterations,
poor concentration .
Intervention:
✔1.Teach patient good sleep hygiene habits.
✔2. Instruct patient to keep asleep diary for 1 week including bed time,
estimated sleep latency , rising time , naps, caffeine intake , time of
exercise.
✔3.Reassure patient that short term insomnia will resolve when the factor
that caused problem are eliminated .
✔4. Determine if it is possible to adjust schedule so that vigorous exercise
occurs several hours before sleep.
✔5. Problem solve with patient how to adjust sleep schedule to avoid
insomnia.
Outcomes:
• 1. Describe factor that prevent or inhibit sleep.
• 2. Report an optimal balance of rest and activity.
Conclusion

Failing to get the proper amount of sleep results in tiredness

during the day. Sleep disorders affect cognitive function
which may cause learning hardships for students, memory
loss in people of all ages, depression, and personality
changes.
Sleep deprivation may also lead to the development of
diabetes, heart disease, mental disorders, and obesity. Sleep
disorders affect cognitive function, which may cause learning
hardships for students, memory loss in people of all ages,
dementia, depression, and personality changes
Questions ??
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listening !